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93-0192
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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93-0192
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Entry Properties
Last modified
5/3/2020 10:37:55 PM
Creation date
12/4/2017 10:36:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
93-0192
STREET_NUMBER
1700
Direction
N
STREET_NAME
DUNCAN
STREET_TYPE
RD
City
LINDEN
SITE_LOCATION
1700 N DUNCAN RD
RECEIVED_DATE
01/25/1993
P_LOCATION
SUSAN BERG
Supplemental fields
FilePath
\MIGRATIONS\D\DUNCAN\1700\93-0192.PDF
QuestysFileName
93-0192
QuestysRecordID
1718648
QuestysRecordType
12
Tags
EHD - Public
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A <br /> r <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P O BOX 2009, STOCKTON, CA 95201 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the Work herein described. This <br /> application is made in Compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin County Public Health Services. <br /> Job Address _ 700 � p UNCA/i /?On- City L-1/t/0'0W Lot Size/Acreage <br /> Owner's Name U n NAddress n 9`5 2 3,C-, Phone 7- Z-70 Z- <br /> Contractor [ 1 Cit-- UVKV CQ, Address21—) / License Na Phone <br /> TYPE Of WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service well 0 <br /> PUMP INSTALLATION 3�-' SYSTEM REPAIR ❑ OTHER C1 Monitoring well ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _ DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> n industrial ❑ Open Bottom 0 Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ,U'Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications <br /> it Public 1-1 Other 1"1 Delta Depth of Grout Seal Type of Grout <br /> i I Irrigation —Approx. Depth I I Eastern Surface Seal Installed by _ <br /> Repair Work Done 0 Type of Pump H.Q H.P. - 12, , State Work Done �� � <br /> Well Destruction ❑ Well Diameter Sealing Material b Depth CJ1 1 IWO <br /> Depth Filler Material b Depth lA_AJ L <br /> TYPE OF SEPTIC WORK; NEW INSTALLATION l I REPAIR/ADOITION I I DESTRUCTION l I (No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence__.._. Commercial— Other <br /> Number of living units: Number of bedrooms <br /> Character of soil to s depth of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments (7) <br /> PKG. TREATMENT PLT.0 Method of Disposal <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE ❑ No. 8 Length of lines Total length/size <br /> FILTER BED n Distance to nearest. Well Foundation Property Line <br /> SEEPAGE PITS 11 Depth Size Number -�! <br /> SUMPS 0 Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin County <br /> Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> certifies the following; "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant must call for all required inspections. omplete drawing on r e se 'de. <br /> Signed X Title: . _,LDate: <br /> R qfPARTMENT USE ONLY g Z <br /> Application Accepted by Date a-)5 [ J Area / <br /> Pit or Grout Inspection by Data Final Inspection by Data 7 <br /> Additional Comments: <br /> Applicant - Return all copies to: San Joaquin County Public Health Services <br /> Environmental Health Permit/Services <br /> 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED r' RECEIVED BY DATE PERMIT-NO. <br /> . EH12SIREV.riN51 ® �!�^� <br /> EH i4-4.2e i`� �/ <br />
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